Provider Demographics
NPI:1508022088
Name:TELIS, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:TELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SCHENCK AVE
Mailing Address - Street 2:APT. 2E
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3642
Mailing Address - Country:US
Mailing Address - Phone:347-782-1448
Mailing Address - Fax:
Practice Address - Street 1:46 SCHENCK AVE
Practice Address - Street 2:APT. 2E
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3642
Practice Address - Country:US
Practice Address - Phone:347-782-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine